Sudden Unexpected Death Risk Higher in Epilepsy

Controlling tonic-clonic seizures can minimize the risk of sudden unexpected death in epilepsy

WEDNESDAY, July 6 (HealthDay News) -- Patients with epilepsy have an increased risk of sudden death compared to the general population, with the most important risk factor being the frequency of generalized tonic-clonic seizures (GTCS), according to a review published online July 6 in The Lancet.

Simon Shorvon, M.D., M.R.C.P., from the University College London Institute of Neurology, and Torbjorn Tomson, M.D., from the Karolinska Institute in Stockholm, Sweden, reviewed the available literature from 1950 to 2010 to analyze the risk factors for sudden death in epilepsy (SUDEP) in 289 cases and 958 living epilepsy controls. They reviewed interventions to minimize the likelihood of sudden death and provided guidelines to clinicians managing patients with epilepsy.

The investigators found that the risk of SUDEP was more than 20 times higher than that of sudden death in the general population. The risk of SUDEP was associated with the frequency of GTCS with an increasing risk associated with more seizures per year. The risk was higher in males than in females, in those with early onset of epilepsy (before the age of 16 years) than in those with onset between 16 to 60 years, in patients on multiple drugs than in those on monotherapy, and in those with epilepsy for longer than 15 years. Treatment changes, reducing GTCS, nighttime supervision of high-risk cases, supervision of patient after a GTCS, recognizing and acting on ictal warning signs, and counseling of patients about risk factors can help reduce SUDEP.

"Although epilepsy is not usually a life-threatening condition, a small number of people do die in epileptic seizures from accidents and SUDEP, and the risk can be minimized by controlling tonic-clonic seizures," the authors write.

Both of the study authors disclosed financial relationships with the pharmaceutical industry.

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